Information technology is at the heart of the Bush administration’s strategy for increasing public awareness of the cost of medical services.

The Centers for Medicare and Medicaid Services is starting to publish information about what it pays hospitals and doctors so consumers can see what their Medicare premiums and tax dollars are buying. CMS started making the Medicare payment information available in June, and more is en route. The agency has already been posting information about hospitals since 2005 so people can compare them.

The campaign was highlighted earlier this year in position papers that accompanied the president’s State of the Union speech. “The president urges medical providers and insurance companies to make information about prices and quality readily available to all Americans prior to the time of service or treatment,” the White House’s Web site states.

The federal government is by no means the only organization offering more transparency. Florida, Massachusetts, New York and Minnesota post such information on their Web sites, and some private insurers and other organizations are doing likewise.

Proponents of greater transparency say the country’s system of third-party payers — insurance companies and government agencies — don’t give the public basic information about the costs and caliber of health care.

“Our medical financing system routinely hides the ball from consumers,” said Mike Leavitt, secretary of the Department of Health and Human Services, in March. “People don’t have a clue what they are paying and have no way of knowing how it compares to what the person in the next room is paying, let alone in the next hospital.”

Armed with more information about the cost and quality of care, people will make better health care choices, the theory goes. In some cases, the mere availability of information can reduce prices because it introduces competition.

Furthermore, reports indicate that physicians with below-average quality ratings leave their profession or specialty at a greater rate than those with higher ratings.

Digging up data
Before the public can openly access medical information, however, IT must extract it from records systems and prepare it for the Web or other publishing format.

Two sources that contain relevant information are clinical records and administrative records. To depict an accurate and fair picture, medical professionals must carefully choose, analyze and present the information for public consumption.

Dr. John Nelson, a Salt Lake City physician and former American Medical Association president, said he recalls that when he was a young doctor, he was criticized for delivering too many babies by Caesarian section. He had delivered 17 babies, and four of those deliveries were Caesarians. He had a sound medical reason for each one, Nelson said, and the low number of deliveries produced a misleading percentage.

“There needs to be clinically accurate data,” he said.

A July article in the Journal of the American Medical Association reported that the correlation is not perfect between publicly reported measures of quality care in treating heart attacks at hospitals and the subsequent rates of death from heart attacks among patients treated at the hospitals.

The study’s authors, from Yale University’s medical school, suggest that more metrics are necessary to get a complete picture of quality.

Some programs, such as one in Florida, adjust data to avoid penalizing hospitals that admit patients who are sicker than average.

Some worry that doctors and hospitals might start turning away patients if treating them would cause their average mortality rates and other quality indicators to suffer.

Doctors and hospitals have not always welcomed the notion of report cards on their services. “There was a lot of pushback from the providers at the beginning of the transparency effort,” Florida Gov. Jeb Bush told fellow members of the federal Medicaid Commission in July. Florida is now encountering less resistance, he said.

Tepid responses?
During a discussion of transparency initiatives at the Medicaid Commission’s July meeting, some people said they were concerned that the Web sites attracted fewer visitors than expected. Dr. David Sundwall, executive director of Utah’s Department of Health, said that in his state medical professionals are more likely to look at the comparative data than patients are. “It’s discouraging,” he said.

Christopher Koller, Rhode Island’s health insurance commissioner, said the state’s posted information does not seem to change patients’ behavior.

But he expressed optimism that site use would increase.

Some officials say the government should consider marketing to be an important component of the sites’ deployment.

Because many government leaders feel the cost and quality of health care are major national issues, the push for transparency is likely to gather steam. Florida is a leader in this area, and Bush said “transparency has helped push the [health care] reforms across the board as much as anything we’ve done.”